AYUSH guidelines for Unani Practitioners for Clinical Management of Dengue Fever

The Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) has launched a practice guideline for Unani practitioners for clinical management of dengue fever.

Dengue fever is known as Hummā Danj in Unani medicine. It is one of the Wabā’ī Amrāz experienced in the past and treated on the pattern of other Wabā’ī Amrāz. Prevention and treatment of Wabā’ī Amrāz has been well described in Unani system of medicine.

Hummā Danj (Dengue Fever) is an acute febrile illness caused by a flavivirus transmitted by the Aedes mosquito and characterized by sudden onset of high fever, severe muscle and joint pain, headache, rash, sore throat, lymphadenopathy and depression.

Aetiology

The causative agent of Dengue Fever is dengue virus which belongs to genus Flavivirus. There are four serotypes of dengue virus – DEN-1, 2, 3 and 4; all produce a similar clinical syndrome and all are transmitted by Aedes aegypti mosquitoes which bite in the daytime and breed in standing water. Infection with one serotype provides life-long immunity to that serotype but not to the other three serotypes.

Humans are infective during the first 3 days of the illness (the viraemic stage). Mosquitoes become infective about 2 weeks after feeding on an infected individual, and remain so for the rest of their lives.

Clinical features

The incubation period is 4 to 6 days (range 3 to 14 days) following the mosquito bite. Asymptomatic or mild infections are common. Two clinical forms are recognized: Classic Dengue Fever and Dengue Haemorrhagic Fever (DHF).

Prodrome

• 2 days of malaise and headache

Acute onset

• Fever:
  
  
  
  • Continuous or 'saddle-back', with break on 4th or 5th day and then recrudescence; usually lasts 7-8 days
  
  
  
  


• Break-bone aching ('break-bone fever'): severe headache, backache, myalgias and arthralgias


• Retro-orbital pain (pain on eye movement)


• Skin rash:
  
  
  
  • Initial flushing faint macular rash in first 1-2 days. Maculopapular, scarlet morbilliform rash from days 3-5 on trunk, spreading centrifugally and sparing palms and soles, onset often with fever defervescence. May desquamate on resolution or give rise to petechiae on extensor surfaces
  
  
  
  


• Relative bradycardia


• Anorexia, Nausea, and Vomiting


• Lymphadenopathy


• Haemorrhagic manifestations:
  
  
  
  • A positive tourniquet test
  
  
  • Petechiae, ecchymoses, purpura
  
  
  • Bleeding per mucosa, GIT, other
  
  
  • Haematemesis, melaena.
  
  
  • Thrombocytopenia <100,000/mm³
  
  
  
  

Convalescence

• Slow

Complications

• Minor bleeding from mucosal sites, hepatitis, cerebral haemorrhage or oedema, rhabdomyolysis

In the past, the Central Council for Research in Unani Medicine has created awareness in the community on the preventive approach to control Dengue Fever. Unani medicines and preventive measures suggested by CCRUM proved fruitful.

Preventive measures for dengue

Primary prevention of dengue is currently possible only with vector control and personal protection from the bites of infected mosquitoes.

• Be aware of countries or areas where dengue fever is endemic.


• Mosquitoes may be in more number close to or on spaces with plenty of trees, so keep away from such spaces.


• Don’t allow any kind of water around your environment.


• Changes to vector habitats: Management of “essential” containers
  
  
  
  • Frequently empty and clean the purposely-filled household containers such as water-storage vessels, flower vases and desert room coolers
  
  
  • Recycle or properly dispose of the rain-filled habitats – including used tyres and discarded food and beverage containers
  
  
  • Shelter stored tyres from rainfall
  
  
  • Manage or remove from the vicinity of homes the plants such as ornamental or wild bromeliads that collect water in the leaf axils
  
  
  
  


• Actions to reduce human–vector contact
  
  
  
  • Install mosquito screening on windows, doors and other entry points
  
  
  • Use insecticide-treated mosquito nets while sleeping during daytime (e.g. infants, the bedridden and night-shift workers)
  
  
  • Wear covered clothes to minimize skin exposure during daylight hours when mosquitoes are most active
  
  
  • Apply mosquito repellents containing DEET, IR3535 or Icaridin to exposed skin or to clothing.
  
  
  • Use household insecticide aerosol products, mosquito coils or other insecticide vaporizers to reduce biting activity.
  
  
  
  

Treatment and management

• Bed rest during the acute phase


• Try to keep temperature below 102°F:
  
  
  
  • Use antipyretics to lower the body temperature:
    
    
    
    • Habb-e-Ikseer Bukhar: 400 mg thrice a day with lukewarm water (NFUM-VI, page 15)
    
    
    • Sharbat-e-Khaksi: 25-50 ml (NFUM-V, page 140)
    
    
    • Malerian: Adult: 6 ml BD, Children: 3 ml BD with warm water, contraindicated for pregnant women (NFUM-VI, page 122)
    
    
    
    
  
  
  • Use cold sponging
  
  
  
  


• Try to avoid Dehydration:
  
  
  
  • Use Oral rehydration solution (ORS)
  
  
  • Use fruit juices like pomegranate juice
  
  
  • Sharbat-e-Anar Shirin: 25-50 ml (NFUM-I, page 221)
  
  
  
  


• Use the Unani drugs possessing immunomodulatory activity to boost your immunity:
  
  
  
  • Khamira Marwareed: 3-5 g (NFUM-I, page 111)
  
  
  
  


• Use the Unani drugs with hepato-corrective and hepato-protective activity to normalize the functions of the liver:
  
  
  
  • Majun Dabid-ul-Ward: 5 g BD (NFUM-V, page 90)
  
  
  
  


• Use Jawarishat to relieve the gastrointestinal symptoms including anorexia, nausea, and vomiting:
  
  
  
  • Jawarish Amla Sada: 5 g BD (NFUM-V, page 71)
  
  
  • Jawarish Anarain: 5 g BD (NFUM-I, page 98)
  
  
  
  

Some Important Prescriptions

Prescription-1

i. Powder the following ingredients and prepare the tablets of 500 mg.

Gilo Khushk (Tinospora cordifolia Miers) 1 Part
Tabasheer (Bambusa bambos Linn.) 1 Part
Tukhm Khurfa Siyah (Portulaca oleracea Linn.) 1 Part

Two tablets twice daily

ii. Sharbat Khaksi: 25 ml twice daily

Prescription-2

i. Habb-e-Ikseer Bukhar: 500 mg twice daily
ii. Sharbat Khaksi: 25 ml twice daily

Prescription-3

i. Sharbat Khaksi: 25 ml twice daily
ii. Majun Dabid-ul-Ward: 5 g twice daily
iii. Khamira Marwareed: 3-5 g twice daily

Prescription-4

The eminent Unani Physicians suggested that the sachet containing the following ingredients may be distributed for prevention. This may be used in the form of decoction or tea.

Afsanteen Artemisia absinthium Linn. 1 Part
Chiraita Swertia chirayita Karst. 1 Part
Kasni Cichorium intybus Linn. 1 Part
Gaozaban Borago officinalis Linn. 1 Part
Nankhuah Trachyspermum ammi 1 Part
Neem Bark Azadirachta indica A. Juss. 1 Part
Saad Kufi Cyperus scariosus R. Br. 1 Part

Always Remember

Nothing to panic

Dengue Fever is a self-limiting disease. Only timely and proper intervention is required to attain perfect health and to prevent complications and fatal outcome. Use preventive measures and medicines as mentioned above. The nearest hospital may be approached for proper treatment.

Clinical research

Clinical studies on Dengue Fever may be conducted in collaboration with modern medical centres so that the life of the patients may be saved in emergency conditions. In active cases of Classic Dengue Fever, supportive Unani treatment for strengthening the Quwwa (Faculties) may be given as an adjuvant therapy to allopathic treatment in order to shorten the duration of illness, and to relieve the symptoms following the acute illness like general weakness and depression. The record of the efficacy of the Unani drugs evaluated may be maintained.